PBS高端访谈:这是奥巴马医改最后一次迎接法律的挑战么?

 　　GWEN IFILL: Now to a momentous¹ day at the Supreme² Court.

　　We begin our coverage³ with the long-awaited ruling on the president's health care law.

　　Marcia Coyle of “The National Law Journal” was in court, as always, and she joins me now.

　　Marcia, 6-3, a pretty — a pretty definite ruling. What was the rationale for the court?

　　MARCIA COYLE, “The National Law Journal”: It was a very straightforward⁴ ruling, and done in only about 21 pages by the chief justice.

　　The challenge before the court was to examine the meaning of a provision in the Affordable⁵ Care Act that explains how subsidies⁶ are to be used. The provision says that subsidies are available to purchase on exchanges established by the state. The challengers here said established by the state means what it says, state exchanges, not subsidies available on the 34 federally created exchanges.

　　The chief justice said initially⁷ that when you look at established by the state, the words seemed pretty plain, but when you look at that phrase and how it's used in other parts of the act, along with other provisions in the act dealing⁸ with federal exchanges, it's not so clear. And since it's not so clear, you have got to examine the words in their context, as well as within the whole structure of the statute⁹.

　　GWEN IFILL: So he was ruling on the intent of the law writers, as opposed to these specific words, which Justice Scalia said was turning the words on their head.

　　MARCIA COYLE: He examined the intent of what Congress did, but he also explained how the act operates, that these subsidies were an integral part of the act being workable.

　　Under the challengers' interpretation¹¹, he said, the act wouldn't work. In fact, it would send insurance markets into a death spiral. And that is not what Congress, he said, wanted to do here. He said they wanted to improve and save the health insurance markets, not destroy them, and the court has a responsibility to pay attention, to be sensitive to the legislative¹² plan. And so it adopted the interpretation that it did because of that.

　　GWEN IFILL: Now, there are some observers, I guess we can call them, who were surprised at this and surprised at the chief justice's definitive¹³ language, especially because he also wrote the ruling upholding the last challenge to the health care law.

　　MARCIA COYLE: He did.

　　The chief justice didn't say much during the oral arguments in this case. He was considered possible vote to strike down the subsidies, but also to uphold them. And I think his very straightforward, clear opinion makes it very clear that he felt this was the best interpretation of the act.

　　Justice Kennedy joined him in the 6-3 majority. Justice Kennedy voted in 2012 to invalidate the entire act because of the individual coverage requirement. But even during the arguments in the current challenge, Justice Kennedy had some problems with what the challengers were saying. So, he was considered gettable as well.

　　GWEN IFILL: Justice Scalia used the opportunity today to read his very strongly worded dissent¹⁴ from the bench.

　　MARCIA COYLE: Yes, he did. He summarized it from the bench, which is always an indication that a justice feels very strongly.

　　And he said that the words established by the state couldn't be plainer. It means established by the state. And he said that the court was engaging in pure applesauce interpretation. He even said, interpretive jiggery-pokery.

　　GWEN IFILL: Wasn't that a “Harry Potter” phrase, I think?

　　MARCIA COYLE: It was actually — it actually has a Scottish derivation.

　　GWEN IFILL: Yes.

　　MARCIA COYLE: And J.K. Rowling tweeted about it, saying she stopped using that phrase something like 20 years ago.

　　But it was a very colorful dissent. But also he went step by step through the statute with his own interpretation of how the provisions worked, and obviously was very unhappy. He was joined by Justices Thomas and Justice Alito in his dissent.

　　GWEN IFILL: Well, I will tell you, it was an interesting, a big day, and we're going to talk about it some more. And we will get back to you on the next case in a moment.

　　MARCIA COYLE: OK.

　　GWEN IFILL: OK.

　　So, is that the end of the fight?

　　For more on what happens next, I'm joined by two experts who helped shape the offense¹⁵ and the defense¹⁶.

　　Neera Tanden is president of the Center for American Progress. She helped write the health care law. And Michael Cannon¹⁷ of the Cato Institute was a leading force behind its challenge.

　　Michael Cannon, you say the Supreme Court was intimidated¹⁸ by this.

　　MICHAEL CANNON, Cato Institute: Well, yes.

　　I think there are a couple of things that are important to keep in mind here. One of them is that it's not just subsidies that we're talking about. There are taxes that are tied to those subsidies that are being imposed on 70 million Americans in those states. And had the challengers won, those taxes would have disappeared, too. So they were actually challenging both the subsidies and these taxes as illegal.

　　Another important thing to keep in mind, I think, is that nine Supreme Court justices said, all nine of them said, you know what, the challengers have a case. The plain meaning of the statute here does do what they say. The plain meaning of the operative part of the statute does do what they say. It does mean established by the state.

　　But because they thought that the purpose of the statute wouldn't be served by the way Congress actually wrote it, they decided¹⁹ to rewrite it.

　　GWEN IFILL: Neera Tanden.

　　NEERA TANDEN, Center for American Progress: No, I don't see it that way at all.

　　I think that Justice Roberts and Justice Kennedy, as well as the other three justices — and I will just note two of those were appointed by conservative presidents — have a very strongly worded opinion which is very definitive.

　　They had an option here, which is to say they could have interpreted it in a way that would allow a future president to interpret differently. They could have used the Chevron²⁰ defense, or a Chevron argument. They chose not to do that.

　　They made a very definitive statement about what this law was intended to do, what this language means in the statute, and found that the plaintiffs were wrong to bring this case, that it was — that they were wrong. And I think the best part about this is the nature of the decision makes it harder to bring future claims. And now my hope is that…

　　GWEN IFILL: Well, that's my next question, which is, is this the end of the road? We heard a lot, including John Boehner, almost every Republican candidate for president, came out today and said this is not the end of the road.

　　MICHAEL CANNON: Well, I don't think it's the end of the road for the opposition²¹ to this law, because the majority or plurality of the public still opposes it, after six years, as they have for six years.

　　And this law doesn't — or this decision doesn't eliminate the law's high cost. It just hides them. And that's why the administration fought this case so vigorously. But I think it's important to note…

　　GWEN IFILL: But is there another way in, other than outright²² repeal²³, after this kind of ruling?

　　MICHAEL CANNON: Well, there are a couple of cases that are making their way through the courts right now. The House of Representatives has filed a suit whose impact would be very similar to a ruling for the challengers in King vs. Burwell. But they're going to have a difficult time establishing standing²⁴. But, if they do so, I think the issues are even clearer than they are in this case.

　　GWEN IFILL: Neera Tanden.

　　NEERA TANDEN: And some cases — I mean, some cases are getting dismissed. There was a case today that got dismissed.

　　Look, my view of this is that this is the second time the Supreme Court has found in favor of the government, and, you know, we are now spending a lot of resources, federal resources to keep relitigating this issue. People had to defend this case.

　　At some point, I think the vast majority of Americans would like to move on from this debate. This isn't about improving the law or making fixes. This effort is really just to undo²⁵ the law, and, at some point, we have to move on.

　　GWEN IFILL: But there are a lot of governors who are still resistant²⁶ to this and who were fighting Medicaid expansion, fighting all kind of bits of this law. How can you say that move on when the debate is still going on?

　　NEERA TANDEN: Actually, you know, what has been interesting, I mean, I — people should debate the law.

　　But what's interesting about the last couple of years is, we have seen Republican governors in states like Michigan, et cetera, Ohio. John Kasich is running for president, and he's actually talking about his Medicaid expansion.

　　GWEN IFILL: But not in Florida or Indiana or 30 other states.

　　NEERA TANDEN: I mean, there's the debate. There are governors who are trying to push in states like Indiana. Discussions are happening in conservative states.

　　I think it's definitely — that is on the Medicaid expansion itself, not on the exchanges. But I think you will see — you see in polling today the vast majority of Americans would like to see how we can improve upon the law, but not get engaged in these legal maneuverings.

　　GWEN IFILL: Well, it's very confusing for people. You just said that most Americans want this law rolled back.

　　And you just said most Americans want this law fixed²⁷.

　　Is there a fix? Is there a middle ground? Is there a common ground?

　　MICHAEL CANNON: Well, I think that what the American people want is, they want health care that is better and more affordable and more secure.

　　The problem is that I think that the centerpiece of this law, which are the — what we call the guaranteed issue of community rating provisions, or the preexisting condition provisions, perversely²⁸, they actually make health care less secure for the people we care about the most, which are the sickest Americans.

　　The problem is that you can't make health care more secure for them until you get rid of that centerpiece of this law, so I think this debate is going to go on for a long time.

　　NEERA TANDEN: That's just — I just disagree with that.

　　And Justice Roberts recognized this. You can have preexisting conditions requirements, making sure that people no longer face just — you know, face the situation where they can't get health insurance because of preexisting conditions. You can do that, but you have to ensure that everyone has health insurance.

　　Justice Roberts articulated how we work together, how all these sections work together, why the subsidies were so important to that. And that's a center part of this decision and the law itself.

　　GWEN IFILL: I have cost questions for both of you.

　　Health care continues to rise at a lower rate, and premiums²⁹ continue to go up.

　　So, for you, I want to know, how do you speak to people who feel like this law is costing them more?

　　And in your case, I'm curious, how do you tell people, we're going to take something away from you that you have already had now for a couple of years?

　　And I will start with you.

　　MICHAEL CANNON: Well, clearly, there is going to be political resistance to that.

　　I think that the easiest way to reduce premiums for people is to get rid of the preexisting condition provisions and all sorts of other regulations in the ACA that increase the cost of care. If you repeal…

　　GWEN IFILL: Isn't that the most popular part of the ACA?

　　NEERA TANDEN: Yes.

　　MICHAEL CANNON: Well, only if you ask about the benefits.

　　If you ask people about the cost, including how it erodes³⁰ the quality of care for the sickest people, then the support for that flips³¹ to 5-1 opposition.

　　GWEN IFILL: Neera Tanden.

　　NEERA TANDEN: So, on the issue of rising costs, we have a challenge, which is employers have been shifting costs to employees.

　　That was before the ACA. That's been a long-term trend. Deductibles are going up, et cetera. It has nothing to do with the ACA, and it's hitting people who have never been in the insurance market in the ACA itself. That's a problem that we should deal with, and we should make it clearer, more transparent³² what's happening.

　　I believe that question will be the next generation of health care ideas, reforms, debates, in the presidential context and outside — and elsewhere, because I think people are concerned about that.

　　But I hope that we can — now that we have had two Supreme Court cases, 50 attempts in the House, we can actually move on to a debate about health care costs writ¹⁰ large.

　　GWEN IFILL: Neera Tanden of the Center for American Progress, and Michael Cannon of the Cato Institute, thank you both very much.

　　NEERA TANDEN: Thank you.

　　MICHAEL CANNON: Thanks for having me.

1 momentous   

adj.重要的，重大的

参考例句：

• I am deeply honoured to be invited to this momentous occasion.能应邀出席如此重要的场合，我深感荣幸。
• The momentous news was that war had begun.重大的新闻是战争已经开始。

2 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。

3 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

4 straightforward   

adj.正直的，坦率的；易懂的，简单的

参考例句：

• A straightforward talk is better than a flowery speech.巧言不如直说。
• I must insist on your giving me a straightforward answer.我一定要你给我一个直截了当的回答。

5 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

6 subsidies   

n.补贴，津贴，补助金( subsidy的名词复数 )

参考例句：

• European agriculture ministers failed to break the deadlock over farm subsidies. 欧洲各国农业部长在农业补贴问题上未能打破僵局。
• Agricultural subsidies absorb about half the EU's income. 农业补贴占去了欧盟收入的大约一半。 来自《简明英汉词典》

7 initially   

adv.最初，开始

参考例句：

• The ban was initially opposed by the US.这一禁令首先遭到美国的反对。
• Feathers initially developed from insect scales.羽毛最初由昆虫的翅瓣演化而来。

8 dealing   

n.经商方法，待人态度

参考例句：

• This store has an excellent reputation for fair dealing.该商店因买卖公道而享有极高的声誉。
• His fair dealing earned our confidence.他的诚实的行为获得我们的信任。

9 statute   

n.成文法，法令，法规；章程，规则，条例

参考例句：

• Protection for the consumer is laid down by statute.保障消费者利益已在法令里作了规定。
• The next section will consider this environmental statute in detail.下一部分将详细论述环境法令的问题。

10 writ   

n.命令状，书面命令

参考例句：

• This is a copy of a writ I received this morning.这是今早我收到的书面命令副本。
• You shouldn't treat the newspapers as if they were Holy Writ. 你不应该把报上说的话奉若神明。

11 interpretation   

n.解释，说明，描述；艺术处理

参考例句：

• His statement admits of one interpretation only.他的话只有一种解释。
• Analysis and interpretation is a very personal thing.分析与说明是个很主观的事情。

12 legislative   

n.立法机构，立法权；adj.立法的，有立法权的

参考例句：

• Congress is the legislative branch of the U.S. government.国会是美国政府的立法部门。
• Today's hearing was just the first step in the legislative process.今天的听证会只是展开立法程序的第一步。

13 definitive   

adj.确切的，权威性的；最后的，决定性的

参考例句：

• This book is the definitive guide to world cuisine.这本书是世界美食的权威指南。
• No one has come up with a definitive answer as to why this should be so.至于为什么该这样，还没有人给出明确的答复。

14 dissent   

n./v.不同意，持异议

参考例句：

• It is too late now to make any dissent.现在提出异议太晚了。
• He felt her shoulders gave a wriggle of dissent.他感到她的肩膀因为不同意而动了一下。

15 offense   

n.犯规，违法行为；冒犯，得罪

参考例句：

• I hope you will not take any offense at my words. 对我讲的话请别见怪。
• His words gave great offense to everybody present.他的发言冲犯了在场的所有人。

16 defense   

n.防御，保卫；[pl.]防务工事；辩护，答辩

参考例句：

• The accused has the right to defense.被告人有权获得辩护。
• The war has impacted the area with military and defense workers.战争使那个地区挤满了军队和防御工程人员。

17 cannon   

n.大炮，火炮；飞机上的机关炮

参考例句：

• The soldiers fired the cannon.士兵们开炮。
• The cannon thundered in the hills.大炮在山间轰鸣。

18 intimidated   

v.恐吓；威胁adj.害怕的；受到威胁的

参考例句：

• We try to make sure children don't feel intimidated on their first day at school. 我们努力确保孩子们在上学的第一天不胆怯。
• The thief intimidated the boy into not telling the police. 这个贼恫吓那男孩使他不敢向警察报告。 来自《简明英汉词典》

19 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

20 chevron   

n.V形臂章；V形图案

参考例句：

• He wore shoulderstrap rank slides with sergeant's chevrons.他佩戴标示级别的肩章，上面有中士的V形标志。
• The chevron or arrow road sign indicates a sharp bend to the left or right.V形或箭头路标表示有向左或向右的急转弯。

21 opposition   

n.反对，敌对

参考例句：

• The party leader is facing opposition in his own backyard.该党领袖在自己的党內遇到了反对。
• The police tried to break down the prisoner's opposition.警察设法制住了那个囚犯的反抗。

22 outright   

adv.坦率地；彻底地；立即；adj.无疑的；彻底的

参考例句：

• If you have a complaint you should tell me outright.如果你有不满意的事，你应该直率地对我说。
• You should persuade her to marry you outright.你应该彻底劝服她嫁给你。

23 repeal   

n.废止，撤消；v.废止，撤消

参考例句：

• He plans to repeal a number of current policies.他计划废除一些当前的政策。
• He has made out a strong case for the repeal of the law.他提出强有力的理由，赞成废除该法令。

24 standing   

n.持续，地位；adj.永久的，不动的，直立的，不流动的

参考例句：

• After the earthquake only a few houses were left standing.地震过后只有几幢房屋还立着。
• They're standing out against any change in the law.他们坚决反对对法律做任何修改。

25 undo   

vt.解开，松开；取消，撤销

参考例句：

• His pride will undo him some day.他的傲慢总有一天会毁了他。
• I managed secretly to undo a corner of the parcel.我悄悄地设法解开了包裹的一角。

26 resistant   

adj.(to)抵抗的，有抵抗力的

参考例句：

• Many pests are resistant to the insecticide.许多害虫对这种杀虫剂有抵抗力。
• They imposed their government by force on the resistant population.他们以武力把自己的统治强加在持反抗态度的人民头上。

27 fixed   

adj.固定的，不变的，准备好的；(计算机)固定的

参考例句：

• Have you two fixed on a date for the wedding yet?你们俩选定婚期了吗？
• Once the aim is fixed,we should not change it arbitrarily.目标一旦确定，我们就不应该随意改变。

28 perversely   

adv. 倔强地

参考例句：

• Intelligence in the mode of passion is always perversely. 受激情属性控制的智力，总是逆着活动的正确方向行事。
• She continue, perversely, to wear shoes that damaged her feet. 她偏偏穿那双挤脚的鞋。

29 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

30 erodes   

侵蚀，腐蚀( erode的第三人称单数 )； 逐渐毁坏，削弱，损害

参考例句：

• The sea erodes the rock. 海水侵蚀岩石。
• The sea erodes the land. 海洋侵蚀陆地。

31 flips   

轻弹( flip的第三人称单数 )； 按（开关）； 快速翻转； 急挥

参考例句：

• Larry flips on the TV while he is on vacation in Budapest. 赖瑞在布达佩斯渡假时，打开电视收看节目。
• He flips through a book before making a decision. 他在决定买下一本书前总要先草草翻阅一下。

32 transparent   

adj.明显的，无疑的；透明的

参考例句：

• The water is so transparent that we can see the fishes swimming.水清澈透明，可以看到鱼儿游来游去。
• The window glass is transparent.窗玻璃是透明的。